WHERE IT HURTS

Ask the Doctor: Best Treatment for Piriformis

And alternative culprits when you think you have a piriformis problem

Published

February 25, 2010

Q: What is the best rehab for piriformis syndrome? I have gone through eight weeks of physical therapy, numerous visits to chiropractor, and 12 weeks of rest. I had three MRIs and back x-rays, all with negative results. I am a 56 year-old female and have been running for 22 years. This is the first injury I've had that has stopped me from running. I'm desperate to get back on the road.

– Chris, AZ

A: Piriformis syndrome typically responds to physical therapy and activity modifications. A cortisone injection may be given in recalcitrant cases. On rare occasions, surgery may be indicated (not many surgeons perform this procedure). Newer procedures, such as injection of plasma rich platelets have not been well studied as a treatment for this problem, but could prove to be helpful.

The piriformis may not be the main culprit for your symptoms. Any structures in the lower back or pelvis may be responsible. Problems with the sacroiliac joint(s) or the symphysis pubis (where the pubic bones meet) may cause inflammation of the piriformis. Tight hip flexors, hip joint problems and disc problems in the spine may all cause pain in the buttocks. There may be inflammation of other gluteal muscles. Hamstring tendinitis at the top of the thigh may cause gluteal pain.

Seek evaluation by a sports medicine specialist or a physical therapist who is adept at evaluating runners. Make sure that you bring copies of all of your MRIs and x-rays (not the reports) when you see a new health care provider.